Exam 3 - Chpt 36 Musculo. Disorders

Question 1

most common form of athritis

Answer 1

osteoarthritis (OA)

Question 2

osteoarthritis used to be called what?

Answer 2

degenerative joint disease (DJD)

Question 3

slow, progressive, non-systemic, non-inflammatory disease

affects articulating and weight bearing joints

Answer 3

osteoarthritis (OA)

Question 4

OA risk factors

Answer 4

trauma
repetitive activities
inflammation
obesity
neuro disorders
skeletal deformities
hema/endocrine disorders
meds
aging
genetics

Question 5

s/sx of OA

Answer 5

pain
loss of function
loss of mobility
coordination, posture
joint stiffness
crepitation
malalignment, deformity
subluxation
Herbenden's nodes
Bouchard's nodes

Question 6

Herbenden’s nodes location

Answer 6

joint closest to finger tip

Question 7

Bouchard’s node location

Answer 7

joint mid finger

Question 8

multiple compartment arthritis effects the __ joint

Answer 8

whole

Question 9

single compartment arthritis effects ___ joint

Answer 9

partical

Question 10

OA s/sx in hips/knees

Answer 10

disabling
uni, bilateral
pain
difficulty sitting, rising
crepitus
flexion deformities
decrease ROM
one leg shorter

Question 11

Dx OA

Answer 11

H&P
XR
CT
MRI
bone scan
ESR
synovial fluid aspiration (not useful in Dx OA but r/o autoimmune disease of the joint such as RA)

Question 12

OA treatment goals

Answer 12

control pain
prevent progression, disability
maintain, restore joint function

Question 13

OA complementary/alternative therapy

Answer 13

acupuncture
massage
Tai Chi
Yoga
TENS

Question 14

OTC OA supplements

Answer 14

Glucosamine

Chondroitin

Question 15

Other OTC OA meds

Answer 15

Acetaminophen (no more than 4G daily)
NSAIDs
Topicals
ASA

Question 16

Rx OA meds

Answer 16

Arthrotec (Diclofenac)
Hyaluronic acid derivatives
Intraarticular corticosteroids

Question 17

OA health promotion measures

Answer 17

eliminate excess strain on joints
proper body mechanics, posture
reduce trauma on joints
no acute, strenuous, repetitive exercise/activity

Question 18

OA home care

Answer 18

safety
pain relief
rest joints - splints
heat/cold
exercise
stretch gloves
sexual counseling

Question 19

long-term corticosteroid use decreases

Answer 19

bone density

Question 20

types of joint surgeries

Answer 20

synovectomy
osteotomy
debridement
arthrodesis
arthroplasty
-reconstruction, replacement of joint; can part of or all the joint

Question 21

acute arthritis characterized by elevation of uric acid in the blood, depositing uric acid crystals into the joint

Answer 21

gout

Question 22

how long can gout flares last

Answer 22

last days to weeks followed by long periods without s/sx

Question 23

how many joints does gout usually occur in

Answer 23

1

Question 24

gout risk factors

Answer 24

more common in men
hyperuricemia
postmenopausal
organ transplant

Question 25

primary hyperuricemia

Answer 25

heredity (error of purine metabolism/overproduction/retention of uric acid) severe dieting/starvation excessive intake of high purine foods

Question 26

secondary hyperuricemia

Answer 26

r/t to another disorder: * meds that inhibit uric acid excretion * increased cell turn over (leukemia, MM, psoriasis, some types of anemia)

Question 27

causes of hyperuricemia

Answer 27

``` acidosis, ketosis alcohol atherosclerosis chemo drugs DM drug-induced renal impairment lead exposure hyperlipidemia HTN malignant disease myeloproliferative disorders obesity, starvation renal insufficiency sickle cell anemia ```

Question 28

common drugs that can lead to hyperuricemia

Answer 28

ASA diuretics: thiazide, furosemide niacin *ethanol (in book, not PPT)

Question 29

will a diet high in purines cause gout?

Answer 29

No but it will lead to a gout attack

Question 30

high purine foods

Answer 30

red meat organ meat shellfish fructose drinks

Question 31

acute gout s/sx

Answer 31

``` precipitating event dusky, cyanotic joint extreme tenderness low grade fever podagra 1 or more joints, but less than 4 subsides 2-10 days ```

Question 32

chronic gout s/sx

Answer 32

multiple joints | tophi

Question 33

gout complications

Answer 33

``` joint deformity OA tophaceous deposits infection kidney/urinary stones renal disease ```

Question 34

how to Dx gout

Answer 34

``` synovial fluid analysis serum uric acid levels 24 hour urine specimen CBC ESR XR ```

Question 35

gout treatment goals

Answer 35

terminate acute attacks prevent future attacks prevent complications

Question 36

gout medication management

Answer 36

``` Colchicine (Colcrys) NSAIDs corticosteriods Benemid Zyloprim (Allopurinol_ Oxypurinol ```

Question 37

nutritional management of gout

Answer 37

low purine diet limit alcohol increase fluids

Question 38

support care for gout

Answer 38

bed rest, immobilize joint careful handling of joint application of heat, cold

Question 39

splint/brace for OA immobilization should not be worn more than how long?

Answer 39

> 1 week

Question 40

is heat or cold therapy more often used for OA?

Answer 40

heat

Question 41

heat therapy is used for ___ whereas cold therapy is used for ___.

Answer 41

heat: stiffness cold: acute inflammation

Question 42

Rx therapist for OA

Answer 42

PT | OT

Question 43

Why are medications taken by OA pts?

Answer 43

symptom management

Question 44

initial analgesic therapy for OA

Answer 44

Acetaminophen

Question 45

caution using Celecoxib in pts with what health issues?

Answer 45

cardiovascular

Question 46

Arthrotec is used where?

Answer 46

hands | knees

Question 47

what occurs with viscosupplementation?

Answer 47

injection of gel-like substance (hyaluronate) into a joint (intra-auricular) *thought to supplement synovial fluid; aim to prevent loss of cartilage, repair defects

Question 48

acute nursing interventions for OA

Answer 48

``` meds balance rest/activity rest the joint heat, cold assist with ADLs body alignment, posture educate ```

Question 49

polypharmacy can lead to ___ changes or overlapping side effects in older adults

Answer 49

arthritic

Question 50

older adults with musculoskeletal pain may not have arthritis but their symptoms may be caused by what?

Answer 50

depression | physical inactivity

Question 51

hyperuricemia is > than

Answer 51

6.8

Question 52

where is tophi usually located?

Answer 52

ear hands great toe

Question 53

symptom free period between gout attacks

Answer 53

intercritical stage